Decompressive Craniectomy, Reperfusion, or a Combination for Early Treatment of Acute “Malignant” Cerebral Hemispheric Stroke in Rats?

Engelhorn, Tobias; Doerfler, Arnd; Kastrup, Andreas; Beaulieu, Christian; Crespigny, Alexander de; Forsting, Michael; Moseley, Michael E.

doi:10.1161/01.str.30.7.1456

Cited by 79 publications

(51 citation statements)

References 50 publications

(44 reference statements)

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“…Following DC and dura opening, the edematous brain may herniate through the craniectomy opening rather than through the tentorial incisura, which prevents brainstem compression (7,8). More sufficient decompression and suitable ICP decreases may be achieved if this extracalvarial movement is bilateral.…”

Section: Discussionmentioning

confidence: 99%

Effect of early bilateral decompressive craniectomy on outcome for severe traumatic brain injury

Akyuz

Uçar²,

Açikbas³

et al. 2009

Turkish Neurosurgery

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AIM:Debate continues as to whether decompressive craniectomy (DC) is an effective treatment for severe traumatic brain injury (STBI). DC is mostly used as a second tier treatment option. The aim of this study was determined whether early bilateral DC is effective as a first tier treatment option in patients with STBI. MATERIAL and METHODS:The study compared two groups. Group 1 comprised 36 STBI patients for whom control of intracranial pressure (ICP) was not achieved with conservative treatment methods according to radiological and neurological findings. These patients underwent bilateral or unilateral DC as a second tier treatment. Group 2 comprised 40 STBI patients who underwent early bilateral DC as a first tier treatment. RESULTS: Group 2 patients had a mean better outcome than Group 1patients, especially for patients with a GCS 6-8. Postoperative ICP was lower in Group 2 patients than Group 1 patients. CONCLUSION: This study indicates that early bilateral DC can be effective for controlling ICP in STBI patients. It is likely the favorable outcome results for Group 2 patients reflects the relatively short time between trauma and surgery. Therefore, these data indicate early bilateral DC can be considered as a first tier treatment in STBI patients.

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Section: Discussionmentioning

confidence: 99%

Effect of early bilateral decompressive craniectomy on outcome for severe traumatic brain injury

Akyuz

Uçar²,

Açikbas³

et al. 2009

Turkish Neurosurgery

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“…1 This spaceoccupying effect causes displacement of midline structures and can lead to cerebral herniation and death. 3,4 Mechanical compression of adjacent brain structures further reduces local cerebral blood flow and thus can cause additional ischemic damage. 4 In the present study we evaluated a noninvasive morphometric technique that allows quantification of the spaceoccupying effect of brain edema in a rat stroke model, using T2-weighted MRI.…”

mentioning

confidence: 99%

“…3,4 Mechanical compression of adjacent brain structures further reduces local cerebral blood flow and thus can cause additional ischemic damage. 4 In the present study we evaluated a noninvasive morphometric technique that allows quantification of the spaceoccupying effect of brain edema in a rat stroke model, using T2-weighted MRI. This method has 2 useful applications in experimental stroke research.…”

mentioning

confidence: 99%

Noninvasive Quantification of Brain Edema and the Space-Occupying Effect in Rat Stroke Models Using Magnetic Resonance Imaging

Gerriets

Stolz

Walberer

et al. 2004

Stroke

182

160

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Background and Purpose-Brain edema is a life-threatening consequence of stroke and leads to an extension of the affected tissue. The space-occupying effect due to brain edema can be quantified in rat stroke models with the use of MRI. The present study was performed to test 2 hypotheses: (1) Can quantification of the space-occupying effect due to brain edema serve as a noninvasive measure for brain water content? (2) Does morphometric assessment of brain swelling allow determination of true infarct size on MRI after correction for the space-occupying effect of edema? Methods-Thirty rats were subjected to permanent suture middle cerebral artery occlusion. MRI was performed after 6 or 24 hours, and hemispheric swelling was assessed morphometrically. Interobserver and intraobserver agreements were determined for MRI measurements. In study I, the space-occupying effect due to brain edema was correlated with the absolute brain water content by the wet/dry method. In study II, lesion volumes corrected and uncorrected for edema were calculated on MRI and on TTC staining and compared. Results-Interobserver and intraobserver agreements for MRI measurements were excellent (rՆ0.97). Brain water content and hemispheric swelling correlated well after 6 and 24 hours (rՆ0.95). Corrected lesion volumes correlated with rϭ0.78 between TTC staining and MRI. Without edema correction, lesion volumes were overestimated by 20.3% after 6 hours and by 29.6% after 24 hours of ischemia. Conclusions-Morphometric assessment of hemispheric swelling on MRI can determine the increase in absolute brain water content noninvasively and can also provide ischemic lesion volumes corrected for brain edema.

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“…The right middle cerebral artery (MCA) was occluded and reperfused via a transvascular approach, as described in detail elsewhere (7,8). For application of radiolabeled microspheres (15 m diameter, 141 CE, 95 Nb or 46 Sc; NEN; Du Pont Co., Boston, MA), animals were intubated and ventilated by using a small-animal respirator.…”

Section: Animal Model and Experimental Protocolmentioning

confidence: 99%

Does a relative perfusion measure predict cerebral infarct size?

Engelhorn¹,

Doerfler²,

Heusch³

et al. 2004

Akt Neurol

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BACKGROUND AND PURPOSE: MR perfusion-weighted imaging (PWI) has been extensively used to quantify cerebral perfusion deficits after the onset of focal ischemia. The present study tested whether a relative measure of cerebral blood flow such as is obtained with PWI is sufficient to predict irreversible tissue damage following focal cerebral ischemia and reperfusion in the rat suture model. METHODS:In rats, the middle cerebral artery was occluded ( CONCLUSION: The present study revealed that absolute CBF is superior to relative CBF in predicting irreversible tissue damage following ischemia and reperfusion.

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Decompressive Craniectomy, Reperfusion, or a Combination for Early Treatment of Acute “Malignant” Cerebral Hemispheric Stroke in Rats?

Cited by 79 publications

References 50 publications

Effect of early bilateral decompressive craniectomy on outcome for severe traumatic brain injury

Effect of early bilateral decompressive craniectomy on outcome for severe traumatic brain injury

Noninvasive Quantification of Brain Edema and the Space-Occupying Effect in Rat Stroke Models Using Magnetic Resonance Imaging

Does a relative perfusion measure predict cerebral infarct size?

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